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First Comes Sex Talk With These Renegades of Couples Therapy

Posted by Planet Waves

If you’ve been reading Planet Waves for a while, you’ve likely seen Eric’s indictments of therapists who do not ask their clients about sexual issues. Surprisingly, that same disconnect exists for most couples’ therapists, too. This piece from The New York Times looks at a few couples’ therapists who start with the question of sex, and considers why it has taken the field so long to get there.

This week’s sex-and-relationships post comes from The New York Times, where you can read it in full (the first half is below). With Mercury having just stationed direct in Libra, conversations about relationships — including about the sex that may or may not be happening to the satisfaction of all involved — are a primary topic. — Amanda P.

By Amy Sohn

Is the classic postcoital question “Was it good for you, too?” outmoded?

A recent conference would indicate yes. Last month, the New York Center for Emotionally Focused Therapy held a symposium in New York called “Sex and Attachment: Coming Together.”

Illustration by Lizzy Stewart for The NYT.

The event, with workshops on polyamory, sex-therapy interventions and compulsive sexual behavior, sold out to 400 clinicians, with a waiting list.

In March, the Psychotherapy Networker Symposium in Washington, D.C., the largest gathering of therapists in North America, offered nine workshops dealing with sexuality, sexual orientation and gender identity. Five years ago, there were only two.

In traditional couples therapy, which is about 50 years old, sex has often been shoved to the sideline. Practitioners are trained to work on underlying relationship issues, like blame or communication, many discussing sex only if the couple wants to talk about it.

But in the last decade, as coupledom itself has been legally redefined, a chorus of provocative voices in couples therapy has emerged, emphasizing the importance of good sex in relationships and sometimes suggesting the radical idea that couples fix the sex before tackling other issues.

These renegades of couples therapy — such as Suzanne Iasenza, Margie Nichols, Jean Malpas, Marty Klein, Joe Kort, Arlene Lev, Marta Meana and Tammy Nelson — have become popular speakers at conferences like “Sex and Attachment.” They speak on topics like affairs, “gender-queerness,” transsexual identity, kink, BDSM (bondage/discipline, domination/submission, sadism/masochism) and pornography to audiences more accustomed to a language of betrayal and forgiveness.

Ms. Perel, based in Manhattan, is writing a book tentatively called “Affairs: Cheating in the Age of Transparency,” and gave a TED talk about the topic in March that has been viewed about two million times. Her newest provocation is the idea that trauma-based language around affairs is limiting.

“An affair is an act of betrayal and also an experience of expansion and growth,” Ms. Perel said in an interview. “It is a relational trauma, but it isn’t a crime. The family can often come out of it stronger and more resilient, and often an affair will draw the couple out of a place of deadness.”

Ms. Perel holds occasional individual sessions in which, by request, she will keep secrets from the other partner in couples work. The goal is for both partners to be honest with the therapist, if not (yet) each other. “Because we agree on this in advance,” Ms. Perel said, “if something comes out and it has to do with an affair, I am never in an ethical breach.”

Another emerging voice on infidelity is Dr. Nelson, 52, a New Haven-based couples and sex therapist and author of “The New Monogamy: Redefining Your Relationship After Infidelity.” She encourages couples to write their own monogamy rules, which can include extramarital sex on weekends or extramarital sex but only together.

“I describe monogamy as honest, perpetual dependency of some type,” Dr. Nelson said. “It can be whatever a couple wants, but it has to be fluid and flexible, and the couple has to keep renewing it, like a license.”

Dr. Iasenza, 59, a psychotherapist in New York, is known for her expansive approach to gender, sexual orientation and pleasure.

She shows her clients sexual-response models like the Basson model, which contradicts the orgasm-focused, human sexual response cycle developed by Masters & Johnson (excitement, plateau, orgasm, resolution), and which posits that a partner can initiate sex for reasons aside from excitement, and arousal may precede desire. (This may be a mind-blowing idea for women who feel, especially after 10-plus years of marriage, that waiting for desire is like waiting for Godot.)

Dr. Iasenza also schedules private sessions with each partner, taking sexual histories and giving them homework to write sexual “menus” (lists of turn-ons), which they later share with each other.

To understand why sex-forward couples therapists may still be considered renegades in the era of shows like “Girls” and “Transparent,” it may help to know that the concept of couples therapy is only slightly older than the Sexual Revolution. It was pushed to the fore in the early 1960s by Don D. Jackson, Virginia Satir and Jay Haley at the Mental Research Institute in Palo Alto, Calif., and Murray Bowen at Georgetown University Medical Center.

Sex therapy, invented by Masters & Johnson, evolved separately — and neither William Masters nor Virginia Johnson was a couples therapist or mental-health provider. Today, there is only one certification program for sex therapists, the American Association of Sexuality Educators, Counselors and Therapists, which means aspiring sex therapists may find access to courses and supervisors a challenge.

And though the association requires its certified sex therapists to be licensed social workers or psychologists first, couples therapists are not required to have any training in sex. Ms. Perel, for example, said she received exactly one hour of education on sex in her psychotherapy training, which led her to become certified in sex therapy in 2010, more than two decades later.

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3 thoughts on “First Comes Sex Talk With These Renegades of Couples Therapy”

Most therapists are not trained in sex; most are still embarrassed; and there is the fear of legal issues arising from false claims of “sexual harassment.” The problem really lies in the training of therapists; comfort with the discussion of sex is a cultivated habit. It takes time and I dare say, considerable knowledge, including the knowledge of sexual history in our society and some others.

I’m a bit baffled at Nelson’s approach to redefining “monogamy” as potentially meaning anything other than having only one sexual partner; this just opens up semantic confusion — using the same word to refer to entirely different things — when IMO it would be more fruitful to explore and develop the vocabulary of relationship in order to dispel such confusion of words and ideas and identify what’s actually important in the relationship.

What Nelson defines as her “new monogamy” sounds an awful lot more like a definition for “commitment” (i.e., dedication to preserve and perpetuate the relationship as a mutual priority), which is distinct from “monogamy” (having only one sexual partner) and “exclusivity” (having only one romantic partner). While these often get presumed as aspects of the same thing, or as an automatic “package deal”, in fact they can exist separately, and any of them may be optional in any given relationship. “Cheating” just means breaking the rules, but the rules are up to the relationship participants to agree upon amongst themselves, including which of these entangled concepts (if any) matters to them.

E.g., I was once involved in a relationship that we agreed would be monogamous, non-exclusive, and non-committed: we only had intercourse with each other, but if the opportunity arose we were free to date and make out with others (short of any activity that could transmit STDs), and we would allow the relationship to dissolve if and when the chemistry fizzled out.

Tyson — I think you make excellent points about Nelson’s confusing use of terminology. My guess is that it’s a way to help fairly “mainstream” couples bridge the divide between what they think relationships “are supposed to be” and what might actually work for them, without introducing the sense of being “out there.” But I think it’s a misguided attempt, in terms of the use of language, when there are already terms out there that can do the job with less convolution.

But other than that, I think some of the therapists featured are onto something; at the very least, it is waaaaaay past time for couples therapists (and all therapists) to address their clients’ sexuality, and to be fully, holistically trained to do so.

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